Grey-scale ultrasound scanning (US), computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP) were performed in a series of 50 patients with known or suspected pancreatic disease. The impact of the individual tests were assessed in the relevant clinical context. With a maximum of 100, the overall clinical impact score of ERCP (75) exceeded that of CT(63) and US (36). In patients with obscure pain, and in those with relapsing pancreatitis, a combination of US and ERCP provides good clinical guidance. Computed tomography scanning can currently be reserved for documentation of patients with a major mass lesion. None of the techniques can detect early pancreatic cancer, except of the papilla of Vater, where ERCP is diagnostic. Recommendations for future diagnostic strategies may alter as grey-scale ultrasonography and computed tomography develop, and, in any case, depend on many factors including local expertise, availability, and cost.
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